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Plaque Control Methods

What is plaque?

Plaque on teeth (dental plaque) is a soft biofilm that coats the tooth surface and dental prosthesis. It is a substance made up of microorganisms, epithelial cells, debris and macrophages found covering the tooth surfaces. Dental plaque leads to the formation of tartar and may progress to dental caries (tooth cavities). It causes various periodontal diseases including gingivitis, periodontitis and periodontal pockets. Plaque control is a process of removal of microbial plaque present over the tooth surface and prevention of accumulation of the same.  The regular removal of plaque eliminates risk of various periodontal diseases and improves dental health.

Picture of plaque on teeth from Wikimedia Commons

Methods of Plaque Control

Plaque can be removed and prevented by both mechanical and chemical means.

Mechanical

The surface of the teeth can be cleaned using mechanical means in a dental clinic by a practitioner or at home by the individual. In a dental set up the mechanical removal of plaque is carried out by the use of scalers. The scaling procedure can be done using hand scalers or ultrasonic instruments. The individual mechanical procedures for plaque control at home consist of use of tooth brushes, dental floss and gingival massage.

Chemical

Chemical methods of plaque control include use of mouthwashes and antibiotic preparations. Mouth washes generally contain chemical substances that prevent the growth of bacteria present in the dental plaque. The most commonly recommended drug for periodontal problemz is a bisbiguanide named chlorhexidine. Other popularly used mouthwashes include essential oil based mouthwashes and triclosan preparations.

Chlorhexidine for Plaque Control

  • Chlorhexidine is used as an adjunct to mechanical plaque control methods as it has a broad spectrum antibiotic activity.
  • It can be used in patients who have undergone recent periodontal surgery as mechanical cleaning may be difficult in these cases.
  • It is also advocated in patients undergoing orthodontic treatment or intermaxillary fixation after oral surgeries.
  • Chlorhexidine is also recommended to the patients with periodontal infections and medically compromised conditions.
  • Long term use of chlorhexidine should be avoided as it may lead to staining of the tooth surface and impaired taste sensation after prolonged use.

Home Dental Care for Plaque Control

  • An ideal tooth brush should poses 1 to 11/4 inch long brush head with 2 to 4 rows of bristles and 80 to 86 bristles per tuft.
  • The recommended frequency of brushing is every 12 hours and the brush should be changed after every three months of usage.
  • The ideal brushing time is 3 to 5 minutes.
  • The technique of tooth brushing advised to an individual depends on the age, type of dentition and underlying periodontal condition of the patient.
  • Specialized brushing techniques for periodontal disorders are demonstrated by a dentist.
  • During regular tooth brushing the brush should make a 45 degree angulation with the tooth surface and 20 strokes of the brush should be performed over at least three teeth at once.
  • Patients with periodontal disorders can use specialized interdental brushes and other cleaning methods.

Flossing is often advised to remove the plaque present in interdental areas. While using the floss one should take precaution not to damage the interdental gingiva by forceful flossing or bruising the gingival margins. Gingival massage using toothbrushes and oral irrigation devices are also used for plaque control.


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